| Doctor Name: | MRS. CLAUDETTE VIVIENNE CLARK |
| NPI Number: | 1053457135 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN,RN,CPNP,IBCLC |
| License Number: | 1-059903 |
| Business Practice Address: | 3851 Roger Brooke Drive Brooke Army Medical Center Fort Sam Houston, TX - 782346200 |
| Business Phone Number: | 2109169233 |
| Business Fax Number: | |
| Mailing Address: | 404 Dickman Rd, SAN ANTONIO |
| State: | TX |
| Postal Code: | 782342604 |
| Phone Number: | 2105953280 |
| Fax Number: | |
| NPI Enumeration Date: | 01/29/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 1-059903 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |